Low Body Mass Index Group Research Articles

Abstracts of the 11th International Conference on Cachexia, Sarcopenia and Muscle Wasting, Maastricht, The Netherlands, 7–9 December 2018 (Part 2)

Abstracts of the 11^th International Conference on Cachexia, Sarcopenia and Muscle Wasting, Maastricht, The Netherlands, 7–9 December 2018 (Part 2)

Body Mass Index as a Risk Factor for Prostate Cancer and Benign Prostate Hypertrophy: a Comparative Study at Three Reference Hospitals in Cameroon

Introduction: Prostate cancer (PCa) is the second most commonly diagnosed cancer and the sixth most common cause of cancer-related mortality among men worldwide. Obesity increases the prevalence and mortality of multiple cancers. Consequently, the relationship between obesity and cancer is receiving more and more attention. Objective: To evaluate the impact of body mass index (BMI) on prostate cancer detection and aggressiveness in Cameroonian population. Methodology: This was a comparative cross-sectional study carried out at the hospitals in Cameroon. The study included Cameroonians who underwent prostate biopsies during a 9-year period, from 2008 to 2016. We analysed the BMI, age, prostate volume, and PSA of patients with prostate cancer in comparison with patients with benign prostate tissue who underwent prostate biopsies. Data entry was performed using CSpro 6.3.2, analysis was done using SPSS version 23.0. Results: A total of 316 patients were included in our study, 158 PCa and 158 BPH. The patients had a mean age ± standard deviation of 67.8 ± 10.32 with a modal class of 61 and 70 years. In our study, the mean age ± SD of the PCa group (71.48 ± 8.96) was significantly greater than that of the BPH group (64.17 ± 10.31) (p 0.05). The median total PSA and the median PSA f/t ratio was significantly different in both groups (p<0.001 and p = 0.006). A Gleason score of 7 was the most frequent. Amongst those with a high BMI 77.5% (55) had a high Gleason score, which was significantly higher than the fraction in the low BMI group (60.9%) (53) (P = 0.026). Conclusion: We therefore conclude that BMI is not an independent risk factor for the development of prostate cancer; rather, it is associated with High Gleason PCa.

Body mass index and parasympathetic nervous system reactivity and recovery following graded exercise

The present study sought to expand upon prior investigations examining patterns of vagally mediated heart rate variability (vmHRV) and perceived exertion as a function of body mass index (BMI) in response to and recovery from exercise. Participants underwent a resting (baseline) period, followed by a graded exercise protocol on an ergometer with ascending difficulty stages, and finally another resting (recovery) period. Individuals were stratified into three BMI groups: low, moderate, and high. Individuals in the high BMI group exhibited a significantly greater decrease in vmHRV from baseline to graded exercise in comparison to the moderate BMI group. Individuals in the high BMI group also showed significantly lower vmHRV at recovery compared with baseline than individuals with moderate BMI; indicating that the high BMI group's vmHRV did not recover to the degree of those in the moderate BMI group. No significant results regarding vmHRV were found in the low BMI group. Of note, BMI and perceived exertion during the recovery period were positively associated. Results also showed a significant negative association between vmHRV and perceived exertion at each grade of exercise. There was no significant association between vmHRV and perceived exertion during baseline or recovery. This report extends prior research studying BMI and patterns of vmHRV reactivity in the domain of physical exercise. Our data contribute to previous reports suggesting that high BMI can lead to maladaptive patterns of vmHRV reactivity to and recovery from physical exercise.

Relationship between the Body Mass Index and Tumor Site Postoperative Complications and Prognosis in Gastric Adenocarcinoma

The impact of BMI on survival in gastric cancer (GC) is not clear. We sought to explore the relationship between BMI and tumor site, clinicopathologic characteristics, postoperative complications, and prognosis in GC patients. Patients who underwent gastrectomy for GC between January 2011 and June 2016 formed the study cohort (n = 827). Patients were divided into three groups according to the BMI (in kg/m²): "low" (<18.5), "normal" (18.5-24.9), and "high" (≥25.0). The preoperative level of albumin and hemoglobin in the low BMI group was lower than that in the high BMI or normal BMI group (P < 0.05). The prevalence of gastric-cardia cancer in the high BMI group was significantly higher than that in the low BMI group (P = 0.001). The prevalence of gastric-antrum cancer in the high BMI group was significantly lower than that in the low BMI group (P = 0.001) and the normal BMI group (P = 0.004). The BMI of patients with gastric-cardia cancer was significantly higher than that of patients with gastric-body cancer (P = 0.018) and gastric-antrum cancer (P < 0.001). There were no significant differences among the three groups in terms of tumor size, TNM stage, depth of tumor invasion, degree of tumor differentiation, resection margin, lymph node metastasis, or postoperative complications. BMI was not an independent factor that influenced the prognosis. We found a relationship between BMI and GC site. A low BMI may be associated with a poor prognosis and a high BMI may be related to a favorable prognosis. BMI was not an independent factor that influenced GC prognosis.

Grasping the weight cut-off for anorexia nervosa in children and adolescents.

The Diagnostic and Statistical Manual of Mental Disorders 5 suggests the 5th age-adjusted body mass index (BMI) percentile as the numeric cut-off for anorexia nervosa (AN) in children and adolescents. We aimed to investigate the degree to which the 5th age-adjusted percentile as the numeric cut-off for AN in youths reflects the clinical population of patients accepted for treatment. From a specialized eating disorder clinic, 305 patients with AN below 18 years of age were grouped according to age-adjusted BMI percentiles [below the 5th (low), above the 10th (high), and between the 5th and the 10th (medium)]. The distribution of eating disorder diagnoses and severity measured by the Eating Disorder Examination was compared. Full-syndrome anorexia nervosa (F.50.0) was found in 182 (59.5%) patients and atypical anorexia nervosa (F.50.1) in 123 patients (40.5%). The number of patients in the low, medium, and high BMI percentile groups was 189 (62.0%), 34 (11.1%), and 82 (26.9%), respectively. Patients in the low BMI group differed from patients in the medium BMI group by a lower frequency of vomiting. The high BMI group presented with more weight and shape concern than the lower BMI group. Age was not a confounder of these associations. We question the applicability of the 5th BMI percentile as a substantiated cut-off for the weight criterion in anorexia nervosa in youths and argue that the cut-off should not be ascribed great clinical importance as this may hinder early detection of illness and initiation of treatment.

Short-term prognosis of emergently hospitalized dialysis-independent chronic kidney disease patients: A nationwide retrospective cohort study in Japan.

In patients with chronic kidney disease (CKD), low body mass index (BMI) is associated with high mortality. This relationship in emergently hospitalized CKD patients is unknown. We investigated the association between obesity and short-term mortality in emergently admitted patients with dialysis-independent CKD (DI-CKD) with and without infection. This retrospective cohort study examined Diagnosis Procedure Combination data of 26103 emergently hospitalized DI-CKD patients. Patients were divided into 8 groups according to their BMI and the presence of infectious diseases. The primary outcome was in-hospital death within 100 days. Cox proportional hazards models adjusted for baseline characteristics showed that low BMI was associated with the outcome both in infected and in non-infected patients (reference group as non-infected and medium BMI [24–26 kg/m2] group): infected and the lowest BMI (≤20 kg/m2) group, hazard ratio (HR) 1.82 (95% confidence interval 1.51, 2.19); non-infected and the lowest BMI group, 1.39 (1.16, 1.67). When patients were stratified according to presence of diabetes mellitus (DM), patients with DM showed that low BMI was associated with the outcome both in infected and in non-infected patients, whereas in non-DM patients, this relationship was attenuated in the non-infected group. For emergently hospitalized CKD patients with infection, high BMI was associated with lower mortality irrespective of the DM status. For non-infected patients, the effects of obesity for in-hospital mortality were modified by the DM status.

Obesity, altered oxidative stress, and clinical correlates in chronic schizophrenia patients

Antipsychotic pharmacotherapy is strongly obesogenic and is associated with increased oxidative stress in patients with schizophrenia. However, whether these changes reflect psychopathology, antipsychotic efficacy, or some other factor is not known. Our study aims to investigate the degree of oxidative stress in different BMI categories and to identify clinical symptomatology that may be paired with increased oxidative stress in a schizophrenia population. To this end, we performed a cross-sectional study and recruited 89 long-term inpatients with schizophrenia and collected the following variables: plasma malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), routine biochemical analysis, and psychopathology through the Positive and Negative Syndrome Scale (PANSS). The results indicate that the levels of the lipid peroxidation product, MDA, were significantly higher in the high BMI group than the low (normal) BMI group. As expected, high BMI was associated with an atherogenic lipid profile; however, it was also associated with fewer psychopathological symptoms. Multiple regression analysis found that MDA levels, the PANSS general psychopathology subscore, and triglyceride levels (all p < 0.05) were independent contributors to the BMI in patients. These results suggested that oxidative stress may play an important role in antipsychotic-induced weight gain. Further investigations using the longitudinal design in first-episode schizophrenia patients are needed to explore the beneficial effect of antioxidants on the abnormal lipid metabolism mediated by antipsychotic treatment.

Association between Body Mass Index and Gastric Cancer Risk According to Effect Modification by Helicobacter pylori Infection.

PurposeFew studies investigated roles of body mass index (BMI) on gastric cancer (GC) risk according to Helicobacter pylori infection status. This study was conducted to evaluate associations between BMI and GC risk with consideration of H. pylori infection information.Materials and MethodsWe performed a case-cohort study (n=2,458) that consists of a subcohort, (n=2,193 including 67 GC incident cases) randomly selected from the Korean Multicenter Cancer Cohort (KMCC) and 265 incident GC cases outside of the subcohort. H. pylori infection was assessed using an immunoblot assay. GC risk according to BMI was evaluated by calculating hazard ratios (HRs) and their 95% confidence intervals (95% CIs) using weighted Cox hazard regression model.ResultsIncreased GC risk in lower BMI group (< 23 kg/m2) with marginal significance, (HR, 1.32; 95% CI, 0.98 to 1.77) compared to the reference group (BMI of 23-24.9 kg/m2) was observed. In the H. pylori non-infection, both lower (< 23 kg/m2) and higher BMI (≥ 25 kg/m2) showed non-significantly increased GC risk (HR, 10.82; 95% CI, 1.25 to 93.60 and HR, 11.33; 95% CI, 1.13 to 113.66, respectively). However, these U-shaped associations between BMI and GC risk were not observed in the group who had ever been infected by H. pylori.ConclusionThis study suggests the U-shaped associations between BMI and GC risk, especially in subjects who had never been infected by H. pylori.

The influence of body mass index on temperature management during general anaesthesia-A prospective observational study.

During general anaesthesia, body core temperature is influenced by several factors that are either anaesthesia-related (type and duration of anaesthesia and fluid management), surgery-related (type of surgery and extent of the surgical procedure), or patient-related (age, gender, body weight, and preoperative body core temperature). Interestingly, data concerning body mass index (BMI) and its influence on patients' temperature are sparse. The aim of this study was to evaluate the impact of BMI on body core temperature under general anaesthesia. A single centre, prospective, observational study was conducted at a university hospital. Two cohorts (lower limb surgery and abdominal surgery) were evaluated. Patients were treated according to actual German guidelines for the prevention of hypothermia. Temperature was measured sublingually prior to anaesthesia and during the first 60minutes of anaesthesia. Each cohort was divided in three subgroups (BMI<24kgm-2 , BMI 25-34.9kgm-2 , and BMI>35kgm-2 ) according to body weight. A total of 206 patients were evaluated. One hundred four underwent lower limb surgery; 102 underwent abdominal surgery. After induction of anaesthesia, temperature dropped in all subgroups, but this decline was more pronounced in patients with lower BMI. Significant differences concerning temperature changes were observed in abdominal surgery between low and high BMI groups. After 60minutes of anaesthesia, group-dependent temperature differences had levelled out, and relevant differences compared with preoperative temperatures could no longer be observed in any of the groups. Current guidelines provide effective protection against perioperative hypothermia. In the current study, this was true for obese as well as normal weight patients.

The Effect of Low Body Mass Index on the Development of Chronic Obstructive Pulmonary Disease and Mortality

Background: Sarcopenia may worsen disease progression and lead to poor outcomes in chronic obstructive pulmonary disease (COPD). However, its effect on the development of COPD is unclear. Methods: We enrolled 437,584 participants registered in the physical health check-up cohort database of the Korean National Health Interview Survey from 2002 to 2003, after exclusion of participants older than 65 years and those previously diagnosed with COPD confirmed by ICD-10 code and prescribed medication. We classified participants according to smoking duration and BMI at baseline. COPD development and mortality were checked for 13 years. Findings: Participants in the low BMI group (<18.5 kg/m2) had a significantly higher rate of COPD development for 13 years (7.6%) than those in other groups (3.4-4.1%; P < .0001). Among never or light smokers, COPD development in the low BMI group (5.6–6.7%) was significantly higher than those in other groups (2.8–4.7%). Similarly, among participants with a smoking history of ≥30 years, same trend was observed (20.1% versus 8.4-12.4%). On multivariable analysis, normal or higher than normal body weight was significantly protective against the development of COPD (hazard ratio [HR], 0.609–0.739; P < .0001) compared to low BMI. It also shows better COPD-free-survival (HR, 491–0.622; P < .0001) and overall survival (HR, 0.440–0.585; P < .0001) compared to low BMI. Interpretation: Low BMI is an important risk factor for COPD development and mortality. Maintaining normal or higher than normal body weight may reduce the risk for COPD development and mortality. Funding Statement: None Declaration of Interests: None Ethics Approval Statement: This study was approved by the Institutional Review Board of Gangnam Severance Hospital (number: 3-2018-0034). The requirement for informed consent was waived considering the retrospective nature of this study.

Sex and body weight are major determinants of venlafaxine pharmacokinetics.

We assessed the effect of body weight and BMI on plasma concentrations of venlafaxine (VEN), O-desmethylvenlafaxine (ODVEN), active moiety (AM=VEN+ODVEN), and dose-corrected plasma concentrations (C/D). A database containing concentrations of VEN and ODVEN including 737 of 1594 eligible patients was analyzed. Analyses included sex, body weight, and BMI as well as concentrations of VEN, ODVEN, AM, and C/D. A positive correlation was detected between body weight and daily dosage (rs=0.168, P<0.001). A negative correlation was found between body weight and AM (rs=-0.124, P=0.001) and ODVEN (rs=-0.137, P<0.001). Negative correlations were also found between body weight and C/D ratios (C/D VEN: rs=-0.134, P<0.001, C/D ODVEN: rs=-0.239, P<0.001, C/D AM: rs=-0.256, P<0.001). No correlations were detected between BMI and concentrations for VEN, ODVEN, and AM. Comparing low-BMI (<20 kg/m²), medium-BMI (20-29.9 kg/m²), and high-BMI (≥30 kg/m²) groups, higher values of some pharmacokinetic variables in the lower BMI group did not remain significant after controlling for sex. Women had higher VEN, ODVEN, AM, and C/D values for AM, VEN, and ODVEN than men (P<0.001 for all comparisons). Our results highlight the role of different pharmacokinetically relevant parameters and foremost of sex as mediators for the effect of BMI on VEN metabolism.

노인 여성의 체력과 비만도 수준에 따른 대사증후군 발생위험률과의 관계

The purpose of this study was to investigate the relationships between total fitness, obesity levels and prevalence rate of metabolic syndrome in elderly female in Korea. A total of 128 subjects (66.89±5.46 years) participated in this cross-sectional study. Total fitness level was determined by sit-up and Grasping power. Metabolic syndrome risks were determined by the diagnostic criteria of the National Cholesterol Education Program Adult Treatment Panel-III (NCEP-APT III). After adjustment for age and BMI (body mass index), high fitness group had significantly decreased TG (triglyceride) and increased HDL-C (high density lipoprotein cholesterol) compared to low fitness group. Low BMI group had significantly decreased WC (waist circumference) and SBP (systolic blood pressure) compared to high BMI group after adjusting for age. When subjects were divided into four groups according to total fitness and obesity levels, s ubj ects w ith high f itness a nd low BMI group h ad 2 2.86 [ OR ( Odds R atio): 2 2.86, 9 5% C I (Confidence interval): 5.31-98.28] times higher prevalence rate of metabolic syndrome than those with low fitness and high BMI. Fitness and obesity levels are strongly associated with increased prevalence rate of metabolic syndrome in elderly female in Korea.

Effects of body habitus on contrast-induced acute kidney injury after percutaneous coronary intervention.

BackgroundLimiting the contrast volume to creatinine clearance (V/CrCl) ratio is crucial for preventing contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, the incidence of CI-AKI and the distribution of V/CrCl ratios may vary according to patient body habitus.ObjectiveWe aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs).MethodsWe evaluated 8782 consecutive patients undergoing PCI and who were registered in a large Japanese database. CI-AKI was defined as an absolute serum creatinine increase of 0.3 mg/dL or a relative increase of 50%. The effect of the V/CrCl ratio relative to CI-AKI incidence was evaluated within the low- (≤25 kg/m2) and high- (>25 kg/m2) BMI groups, with a V/CrCl ratio > 3 considered to be a risk factor for CI-AKI.ResultsA V/CrCl ratio > 3 was predictive of CI-AKI, regardless of BMI (low-BMI group: odds ratio [OR], 1.77 [1.42–2.21]; P < 0.001; high-BMI group: OR, 1.67 [1.22–2.29]; P = 0.001). The relationship between BMI and CI-AKI followed a reverse J-curve relationship, although baseline renal dysfunction (creatinine clearance <60 mL/min, 46.9% vs. 21.5%) and V/CrCl ratio > 3 (37.3% vs. 20.4%) were predominant in the low-BMI group. Indeed, low BMI was a significant predictor of a V/CrCl ratio > 3 (OR per unit decrease in BMI, 1.08 [1.05–1.10]; P < 0.001).ConclusionsA V/CrCl ratio > 3 was strongly associated with the occurrence of CI-AKI. Importantly, we also identified a tendency for physicians to use higher V/CrCl ratios in lean patients. Thus, recognizing this trend may provide a therapeutic target for reducing the incidence of CI-AKI.

Body mass index as independent predictor of overall survival in patients with advanced renal cell carcinoma at start of systemic treatment—Analyses from the German clinical RCC-Registry

ObjectivesA high body mass index (BMI) is associated with an increased risk for developing renal cell carcinoma (RCC), a higher complication rate after surgery, and a postoperative decline in renal function after nephrectomy. In contrast, a high preoperative BMI has been associated with increased survival in patients with localized RCC. We examined the prognostic impact of the BMI in patients treated for metastatic RCC (mRCC) in daily routine practice in Germany. Patients and MethodsThe ongoing prospective, multicenter German clinical cohort study on mRCC (RCC-Registry) has recruited patients from more than 110 oncology/urology outpatient centers and hospitals at initiation of systemic first-line treatment. Data on patients’ demographics, treatment, and outcome in routine practice, so called “real world data”, have been collected. For this analysis, 606 patients were stratified into a low (BMI < 24), medium (24 < BMI < 28), and high (BMI > 28) BMI group. The influence of the BMI on the overall survival (OS) was analyzed using a multivariate Cox proportional hazards model. ResultsMedian OS was 24.5 (95% confidence interval [CI], 19.3–28.5), 17.9 (95% CI, 15.3–20.8) and 10.9 (95% CI, 7.3–13.4) months in the high, medium, and low BMI patient group, respectively. A significant correlation of BMI with OS, independent of other factors, was found (low vs. high BMI: hazard ratio (HR): 1.94, 95% CI, 1.48–2.54; medium vs. high BMI: HR: 1.40, 95% CI, 1.10–1.78). Memorial Sloan Kettering Cancer Center risk factors were independently correlated with shorter OS. ConclusionsOur analysis showed a significant and independent correlation of a high BMI with longer OS in a prospective German cohort of mRCC routine patients starting first-line systemic treatment.

Usefulness of real-time contrast-enhanced ultrasound guided coaxial needle biopsy for focal liver lesions.

To evaluate the utility of real-time contrast-enhanced ultrasound (CEUS)-guided coaxial needle biopsies for focal liver lesions (FLL) that were inconspicuous or could not be accurately identified the active site on B-mode ultrasound (US). This prospective study included 76 patients who had CEUS-guided coaxial needle biopsies for FLL between December 2015 and June 2017. We recorded characteristics of target lesions. We evaluated conspicuity of target lesions and accuracy of identifying the active site of target lesions on B-mode US and CEUS using a 5-point scale. Patients were divided into three groups, and analyzed according to body mass index (BMI). Based on the final diagnosis, the diagnostic performance was evaluated. The mean size and depth of target lesions were 41.5 ± 28.5 and 47.9 ± 18.9mm on CEUS, respectively. In arterial phase, the enhanced pattern of target lesions varied. The conspicuity of target lesions and accuracy of identifying the active site of target lesions was significantly improved on CEUS compared to B-mode US (p < 0.05). The three BMI groups had significant differences in conspicuity of target lesions after using CEUS (p < 0.05). The high BMI group had a greater change in conspicuity of lesions compared to the normal BMI group or the low BMI group (p < 0.05). The sensitivity, specificity, and accuracy of this technique for the diagnosis of FLL were 92.8%, 100%, and 93.4%, respectively. Real-time CEUS-guided coaxial needle biopsy can be very useful for FLL that are inconspicuous or cannot be accurately identified the active site on B-mode US.

High Body Mass Index is Related to Increased Perioperative Complications After Periacetabular Osteotomy.

The purpose of this study is to determine the relationship of body mass index (BMI), age, smoking status, and other comorbid conditions to the rate and type of complications occurring in the perioperative period following periacetabular osteotomy. A retrospective review was performed on 80 hips to determine demographic information as well as pre- and postoperative pain scores, center-edge angle, Tönnis angle, intraoperative blood loss, and perioperative complications within 90 days of surgery. Patients were placed into high- (>30) and low- (<30) BMI groups to determine any correlation between complications and BMI. The high-BMI group had a significantly greater rate of perioperative complications than the low-BMI group (30% vs 8%) and, correspondingly, patients with complications had significantly higher BMI than those without (30.9 ± 9.5, 26.2 ± 5.6) (P = .03). Center-edge angle and Tönnis angle were corrected in both groups. Improvement in postoperative pain scores and radiographically measured acetabular correction can be achieved in high- and low-BMI patients. High-BMI patients have a higher rate of perioperative wound complications.

Wednesday, September 26, 2018 2:00 PM – 3:00 PM Integrating Technology into Practice: 61. Clinical photographs in the assessment of adult spinal deformity: a comparison to radiographic parameters

BACKGROUND CONTEXT Adult spinal deformity (ASD) patients are exposed to a substantial radiation burden. Full spine imaging is not available in every clinic. A photographic method of deformity assessment would allow for less frequent radiographic assessment. PURPOSE To investigate whether people with large PI have increased correction following pedicle subtraction osteotomy. STUDY DESIGN/SETTING Prospective of photographic and X-ray analysis of ASD patients. PATIENT SAMPLE A total of 38 patients. OUTCOME MEASURES Pre- and postoperative alignment with global spinal parameters, photographic clinical TPA measurements. METHODS Standing full spine X-ray studies were obtained, and clinical photographs were taken with reflective markers placed overlying C2, T1, and S1, as well as the greater trochanter (GT, sagittal only) and each PSIS (coronal only). Linear regressions were performed between X-ray parameters and their photographic “equivalents.” In the sagittal plane, these included T1 pelvic angle (TPA: T1 body to femoral heads to S1) vs. TPA clinical (TPAc: T1 to GT to S1), and cervical pelvic angle (CPA: C2 body to femoral heads to S1) vs. CPA clinical (CPAc: C2 to GT to S1). In the coronal plane, regressions included pelvic obliquity (PO: iliac crest line and horizontal) vs. PO clinical (POc: PSIS line and horizontal) and T1 tilt (T1–S1 line and vertical) versus T1 tilt clinical (T1–S1 and vertical). The same regressions were repeated after stratifying into low ( 30) BMI groups. RESULTS Thirty-eight patients were enrolled. Sagittal deformity parameters were highly correlated (means: TPA 24.9°, TPAc 37.0°, r=.77; CPA 28.3°, CPAc 40.2°, r=.77; both p CONCLUSIONS Spinal deformity patients are exposed to a substantial radiation burden. A reliable method of deformity assessment based on clinical photographs would allow for less frequent radiographic assessment. Photographic measurements of spinal deformity were developed and compared to analogous radiographic parameters. They were found to be highly correlated in both the sagittal and coronal planes. Correlations were generally higher in patients with low BMI. Such measurements in clinical photographs could replace X-ray imaging in certain scenarios or they can be a substitute where full spine radiographs are unavailable. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Association Between Interdialytic Weight Gain, Perception About Dry Weight, and Dietary and Fluid Behaviors Based on Body Mass Index Among Patients on Hemodialysis

This study aimed to identify dietary and fluid behaviors associated with relative interdialytic weight gain (RIDWG) (divided by the respective dry weight [DW]) by stratifying the patients according to body mass index (BMI). This was a cross-sectional, multicenter investigation. Between July 2016 and March 2017, data were collected from 4 Japanese dialysis centers in 3 cities. The patients (n=577) were asked to reply to a self-completed questionnaire, including questions on perception about DW and dietary and fluid behaviors. The differences in perception about DW and dietary and fluid behaviors were compared between RIDWG nonadherence (average RIDWG ≥5％ a month) and adherence subgroups. The 360 participants were stratified into thin (<20; 28.6%), normal low (≥20 and<22; 22.5%), normal high (≥22 and<25; 31.7%), and overweight (≥25; 17.2%) groups on the basis of BMI. In the thin and normal low BMI groups, the RIDWG nonadherent patients were more likely to identify their DW as "looking to increase." Although the difference was less prominent between the adherence subgroups in the thin BMI group, the RIDWG nonadherent patients in normal low BMI group seemed to generally take less care to intentionally regulate their behaviors as a representative of sodium-intake/fluid management. Although patients with a larger body size (overweight and normal high BMI groups) were not associated with this perception about DW, they were associated with some demographic characteristics; regarding the normal high BMI group, a higher proportion of RIDWG nonadherent patients worked full-time, and they more frequently reported an irregular eating pattern. Dietary and fluid behaviors associated with RIDWG differed according to the BMI group. Assessing more specific types of patient behaviors, focusing on the underlying factors associated with dietary and fluid behaviors, and taking BMI into consideration are required.

Association between metabolic syndrome and osteoporosis in Taiwanese middle-aged and elderly participants

SummaryThis study examined the association between metabolic syndrome and osteoporosis among middle-aged and elderly Taiwanese participants. After controlling for body mass index, age, liver and renal functions, and nutrition and exercise statuses, we found no significant association between MS and osteoporosis in either gender.PurposeThe term metabolic syndrome (MS) encompasses different abnormalities with independent effects on bone metabolism, which has led to inconsistencies in the association between MS and osteoporosis. This study evaluated this association among middle-aged and elderly Taiwanese participants by adjusting relevant covariates.MethodsWe enrolled 2007 participants (1045 men and 962 women) older than 50 years, who underwent a health examination at a preventive examination agency in urban Taiwan. We studied age, gender, diabetes mellitus and hypertension histories, smoking and exercise statuses, metabolic and nutrition indices, and liver and renal function profiles. We conducted multiple logistic regression analyses to examine the association between MS and osteoporosis by categorizing participants in terms of gender and body mass index (BMI).ResultsOverall, men with osteoporosis were less likely to have MS, and displayed fewer MS components than men without osteoporosis; but we found no significant associations between MS, or its components, and osteoporosis in women. After forming two groups according to BMI and adjusting for covariates, we found no association between MS and osteoporosis in any group. Multiple logistic regression analysis revealed that regular exercise had a negative association with osteoporosis in the low BMI group for men (OR, 0.365; p = 0.008).ConclusionsAfter BMI stratification and adjustments for age, nutrition status, liver and renal functions, and exercise status, we found no significant association between MS and osteoporosis in either gender. Regular exercise may prevent osteoporosis, particularly in men with a lean body mass.

Efficacy of Utilizing Argon Plasma Coagulation for Weight Regain in Roux-en-Y Gastric Bypass Patients: a Multi-center Study.

Endoscopic approaches exist for targeting weight regain after Roux-en-Y gastric bypass (RYGB), including endoscopic suturing, clipping, and sclerotherapy. Argon plasma coagulation (APC) is a noncontact electrocoagulation method, and when used in RYGB patients, it has shown reduction in the diameter of the gastrojejunal anastomosis. To study the effectiveness of APC for weight regain in terms of weight loss for RYGB patients, from eight bariatric centers. A retrospective chart review was performed for 558 patients at eight bariatric centers in the USA (1) and Brazil (7) who underwent APC procedure between 31st July 2009 and 29th March 2017. APC was performed on patients who regained weight after RYGB procedure. Upon exploratory analysis of the individual BMI data, the mean BMI decreased slightly during the first 24months and increased slightly afterwards following the APC intervention. The mean weight was 94.5 ± 18.6kg and the mean BMI was 34.0kg/m2 at APC. Where data were available, the mean of lowest weight was 67.0 ± 23.0kg and the mean of lowest BMI was 24.1kg/m2 following gastric bypass. The mean weight loss was 6.5, 7.7, and 8.3kg at 6, 12, and 24months, respectively, and the changes in weight over time was statistically significant (p < 0.0001). Multi-level for change model showed the low body mass index (BMI) group (BMI < 30kg/m2) to have greater TWL than the high BMI (BMI ≥30kg/m2) group at 6, 12, and 24months. In the low BMI group, the mean TWL was 4.7, 6.1, 6.9, and 2.4%, at 6, 12, and 24months, respectively. In the high BMI group, the mean TWL was 7.5, 10.4, 13.4, and 3.7%, at 6, 12, 24, and 36months, respectively. Of the 333 patients in four centers who provided complication information, complications after APC included stenosis (n = 9), GJ ulcer (n = 3), vomiting (n = 3), GJ leakage (n = 2), and melena (n = 1). APC can be useful in reducing the regained weight after RYGB, and patients showed 6-10% total weight loss at 12months. Randomized trials would be needed to validate the findings.